Psychoneuroimmunology

Psychodermatological disorders: recognition and treatment

Many dermatological disorders have a psychosomatic or behavioral aspect. Skin and brain continually interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly affect the initiation or flaring of skin disorders. It is important to consider these mind-body interactions when planning treatments for specific skin disorders in individual patients. Mind-influencing therapeutic options that can enhance treatment of skin disorders include standard psychotropic drugs, alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When individual measures do not produce the desired results, combinations of drugs or addition of non-drug therapies may be more successful. Psychophysiological skin disorders may respond well to non-drug and drug therapies that counteract stress. Treatment of primary psychiatric disorders often results in improvement of associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment. Therapeutic options for each of these are discussed.

The role of psychoneuroimmunology in personalized and systems medicine

Psychoneuroimmunology (PNI) may provide the scientific basis for personalized and systems medicine. The exploration of the extensive interactions among psychological and behavioral factors, the nervous system, the immune system, and the endocrine system may help understand the mechanisms underlying health, wellness, and diseases. PNI theories based on systems biology methodologies may contribute to the identification of patient patterns for establishing psychological and physiological profiles for personalized medicine. A biopsychosocial model will help elucidate the systemic interrelationships between psychosocial and bio-physiological factors for the development of systems medicine. Many evidences have supported the close relationships between stress, depression, inflammation, and disorders including obesity, cardiovascular disease, diabetes, arthritis, skin diseases, infectious diseases, and sleep disorders. As inflammation is a critical connection among different diseases, the elucidation of the associations may contribute to the findings of systemic therapeutic targets. With the understanding of the translational implications of PNI, integrative interventions in multiple dimensions can be applied to modulate stress responses and promote healthier behaviors. These interventions include combination drug therapies, diets, nutritional supplements, meditation, and other behavioral and mind-body strategies.

Chronic cold stress in mice induces a regulatory phenotype in macrophages: correlation with increased 11β-hydroxysteroid dehydrogenase expression

Susceptibility to infections, autoimmune disorders and tumor progression is strongly influenced by the activity of the endocrine and nervous systems in response to a stressful stimulus. When the adaptive system is switched on and off efficiently, the body is able to recover from the stress imposed. However, when the system is activated repeatedly or the activity is sustained, as during chronic or excessive stress, an allostatic load is generated, which can lead to disease over long periods of time. We investigated the effects of chronic cold stress in BALB/c mice (4°C/4 h daily for 7 days) on functions of macrophages. We found that chronic cold stress induced a regulatory phenotype in macrophages, characterized by diminished phagocytic ability, decreased TNF-α and IL-6 and increased IL-10 production. In addition, resting macrophages from mice exposed to cold stress stimulated spleen cells to produce regulatory cytokines, and an immunosuppressive state that impaired stressed mice to control Trypanosoma cruzi proliferation. These regulatory effects correlated with an increase in macrophage expression of 11β-hydroxysteroid dehydrogenase, an enzyme that converts inactive glucocorticoid into its active form. As stress is a common aspect of modern life and plays a role in the etiology of many diseases, the results of this study are important for improving knowledge regarding the neuro-immune-endocrine interactions that occur during stress and to highlight the role of macrophages in the immunosuppression induced by chronic stress.

Translation of psychoneuroimmunology into personalized medicine: a systems biology perspective

With its multidimensional features and systems biology approaches, developments in psychoneuroimmunology may provide the basis for the translation of scientific discoveries into personalized and systems medicine. To achieve this goal, several key issues need to be emphasized and resolved. These key issues include the identification of biomarkers for accurate diagnosis and treatment, the understanding of the systems interactions and networks, and the systemic profiling of patient subgroups. Recognition of systemic biomarkers may provide insight into the complex multidirectional interactions among psychological and behavioral factors, the nervous system and the immune system. Systems biology studies of complex mechanisms such as inflammation at various levels may enable the discovery of common targets for different diseases from depression to cancer. Such elucidation would enable the classification of patient patterns and subgroups for personalized interventions. Understanding of these key issues would contribute to the establishment of systems models and the development of integrative prevention and treatment strategies in multiple dimensions.

Quality of life in dermatomyositis

BACKGROUND

Quality of life (QoL) for patients with inflammatory skin disease can be significant, but has been evaluated in just one study in dermatomyositis (DM).

OBJECTIVE

We sought to examine the relationship between the Cutaneous Dermatomyositis Area (CDASI) and Severity Index, a DM-specific cutaneous severity instrument, and various QoL study instruments and to determine the impact of DM on QoL.

METHODS

Skin-specific QoL instruments, the Skindex and the Dermatology Life Quality Index, and global medical QoL instruments, the Short Form 36 and the Health Assessment Questionnaire-Disability Index, were used. Pruritus was evaluated by a visual analog scale and a 0-to-10 scale in DM and cutaneous lupus erythematosus (CLE) populations, respectively.

RESULTS

There was a significant correlation between the CDASI and all skin-specific QoL scores (lowest P = .0377). Using the Short Form 36, DM population was found to have significantly worse QoL scores than the general population with the exception of bodily pain (all subscore P values < .01). Furthermore, DM had a significantly lower vitality score, representing energy level, compared with CLE, hypertension, diabetes, and recent myocardial infarction scores (lowest P = .003). There was a significantly lower mental health score, representing overall mood, to all compared diseases except CLE and clinical depression (P values < .01 when significant). We found that DM produces more pruritus than CLE (P < .0001).

LIMITATIONS

A larger patient population needs to be studied to further assess QoL in patients with DM.

CONCLUSION

We conclude that DM has a large impact on QoL, even when compared with other diseases, and that DM skin disease activity correlates with a poorer QoL.

Risk and Resilience in Coping With Chronic Life Stress

This review discusses evidence-based perspectives on risk and resilience in coping with chronic life stress. Future directions for inquiry and practice also are addressed.

Periodontal nitric oxide pathway alteration due to precompetition anxiety in handball players

BACKGROUND

Psychologic and physical stress is known to be related with periodontal disorders. The objective of this study is to investigate salivary and gingival crevicular fluid (GCF) nitric oxide (NO) metabolism and its association with the periodontal reaction to precompetition anxiety in competitive athletes.

METHODS

A total of 18 elite male handball players participated in this study. The anxiety level of participants was determined by using a competitive state anxiety inventory-2 (CSAI-2). Periodontal clinical measurements, saliva, and GCF samples were obtained before the application of the CSAI-2 during the half-season break and just before the league championship match. NO-level, arginase, and NO synthase (NOS) activities were analyzed in saliva samples; NO and basic fibroblast growth factor (FGF-b) levels were analyzed in GCF samples.

RESULTS

The CSAI-2 was significantly different between the two evaluation time points. GCF NO and FGF-b levels increased before the championship match, whereas saliva levels did not change. The plaque index and gingival index (GI) increased at the evaluation just before the championship match. The difference in the GI was statistically significant.

CONCLUSION

The competitive stress of athletes may lead to a gingival/periodontal disturbance accompanied by an altered NO metabolism in saliva and GCF.

Lecturing to 200 students and its effects on cytokine concentration and salivary markers of adrenal activation

Stress not only activates the SAM system and the hypothalamic-pituitary-adrenal axes, but also the immune system. The aims of this study are to assess the physiological variations in saliva (cytokines, cortisol and alpha-amylase) and perceived stress in professors when they had to lecture to 200 students. A total of eight unstimulated saliva samples were collected from nine professors: four on a working day that included the lecture and four controls on a working day without a lecture. The professors also rated subjective stress on a seven-point scale 5 min before the lecture, immediately after the lecture and at the same times on the control day. The lecture elicited substantial increases in subjective stress ratings, with the values on the lecture day significantly higher than those on the control day. Lecturing resulted in significant increases in Tumor Necrosis Factor (TNF)-α, Interleukin (IL)-2 and IL-4 concentrations, but did not affect the IL-10 values. These changes appeared to be concomitant with changes in the concentrations of the stress markers, alpha-amylase and cortisol. The mechanisms by which psychosocial stress can induce cytokine changes and modify the activity of salivary alpha-amylase are not entirely understood, and further research is thus warranted.

Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report

INTRODUCTION

Myasthenia gravis is a neuromuscular junction post-synaptic autoimmune disorder. Myasthenic crisis is characterized by respiratory failure requiring mechanical ventilation. Takotsubo cardiomyopathy is a rare clinical syndrome defined as a profound but reversible left ventricular dysfunction in the absence of coronary artery disease.

CASE PRESENTATION

We report a unique case of a 60-year-old Hispanic woman with myasthenia gravis who developed takotsubo cardiomyopathy and concomitant myasthenic crisis that appear to have been triggered by a stressful life event. On admission, she presented with severe mid-sternal chest pain and shortness of breath shortly after a personally significant stressful life event. A pertinent neurological examination showed bilateral facial weakness and right ptosis. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments with sparing of the apex. Her troponin I level was elevated, while cardiac catheterization revealed no significant coronary artery disease. The findings were consistent with takotsubo cardiomyopathy. Shortly after cardiac catheterization, she developed bilateral ophthalmoparesis and significant bulbar and respiratory muscle weakness. Forced vital capacity values were persistently less than 1 L. The patient developed respiratory failure and required endotracheal intubation. After plasmapheresis and corticosteroid treatment, her clinical course improved with successful extubation. A normal left ventricle chamber size and a normal ejection fraction were noted by an echocardiogram repeated 10 months later.

CONCLUSION

This is the first reported case of the simultaneous triggering of both takotsubo cardiomyopathy and myasthenic crisis by the physiologic consequences of a state of severe emotional stress. We hypothesize that the mechanism underlying the rare association of takotsubo cardiomyopathy with myasthenic crisis involves excessive endogenous glucocorticoid release, a high-catecholamine state, or a combination of both. We advocate careful cardiac monitoring of myasthenia gravis patients during acute emotional or physical stress, as there is potential risk of developing takotsubo cardiomyopathy.

Erratum: Psychoneuroimmunology: application to ocular diseases

Psychoneuroimmunology (PNI) is a relatively new discipline within the field of neuroscience which researches the relationship between emotional states, the central and peripheral nervous systems, and the endocrine and immune systems. Negative psychological states, such as stress, anxiety, and depression, may alter immune system regulation and modulation of peripheral cytokines. A plethora of PNI studies have shown that increased psychological stress and depression are associated with an alteration of immune functioning and worsened health outcomes for many conditions. To date, application of PNI methodology has not been reported for ocular diseases. This article provides an historical perspective on the origins of the rift between the emotional and spiritual from physical aspects of disease. A review of how stress is mediated through sympathetic adrenomedullary and hypothalamic pituitary axis activation with shifts in immunity is provided. The literature which supports spirituality in healing is presented. Finally, ocular diseases which would be most amenable to a PNI approach are discussed.

Aging and cancer: converging routes to disease prevention

An integrative approach to the combined challenges of aging, cancer and stress is a necessary part of a global vision of wellness. Recent research into the mechanisms of aging, cancer and stress has established the biological links between these processes. Understanding these links is an important stepping-stone for developing approaches and therapies that ensure wellness throughout all stages of aging. This paper will consider the most recent developments in research into the molecular mechanisms common to aging and cancer and will discuss the effectiveness of natural approaches for preventing disease. Metabolic regulators as well as nutrient and energy sensors are involved in the processes of aging and cancer, and these are open to external manipulation and control. It is now becoming possible to demonstrate how nutrition, physical activity and stress control can lead to disease-free aging.

Psychoneuroimmunology: application to ocular diseases

Psychoneuroimmunology (PNI) is a relatively new discipline within the field of neuroscience which researches the relationship between emotional states, the central and peripheral nervous systems, and the endocrine and immune systems. Negative psychological states, such as stress, anxiety, and depression, may alter immune system regulation and modulation of peripheral cytokines. A plethora of PNI studies have shown that increased psychological stress and depression are associated with an alteration of immune functioning and worsened health outcomes for many conditions. To date, application of PNI methodology has not been reported for ocular diseases. This article provides an historical perspective on the origins of the rift between the emotional and spiritual from physical aspects of disease. A review of how stress is mediated through sympathetic adrenomedullary and hypothalamic pituitary axis activation with shifts in immunity is provided. The literature which supports spirituality in healing is presented. Finally, ocular diseases which would be most amenable to a PNI approach are discussed.

Combination treatment with progesterone and vitamin D hormone may be more effective than monotherapy for nervous system injury and disease

More than two decades of pre-clinical research and two recent clinical trials have shown that progesterone (PROG) and its metabolites exert beneficial effects after traumatic brain injury (TBI) through a number of metabolic and physiological pathways that can reduce damage in many different tissues and organ systems. Emerging data on 1,25-dihydroxyvitamin D(3) (VDH), itself a steroid hormone, have begun to provide evidence that, like PROG, it too is neuroprotective, although some of its actions may involve different pathways. Both agents have high safety profiles, act on many different injury and pathological mechanisms, and are clinically relevant, easy to administer, and inexpensive. Furthermore, vitamin D deficiency is prevalent in a large segment of the population, especially the elderly and institutionalized, and can significantly affect recovery after CNS injury. The combination of PROG and VDH in pre-clinical and clinical studies is a novel and compelling approach to TBI treatment.

Current concepts in psychodermatology

Dermatology is a discipline in which psychosomatic issues serve a key purpose in helping us understand the etiology and progression of skin diseases and determining appropriate treatment protocols. Emotional factors appear to significantly influence most skin diseases, and the correlation between stressful life events and disease flares is well recognized in dermatology. In this article, recent research is highlighted for major cutaneous disease states, as well as psychiatric disorders with symptoms that present as skin disorders. The role of the expanding field of psychoneuroimmunology as it pertains to dermatologic disorders is discussed. The author also presents recommendations for optimal evaluation and management of psychosocial concerns in the dermatology patient population.